World journal of emergency medicine最新文献

BACKGROUND: In-flight medical emergencies (IMEs) present significant challenges to healthcare professionals, particularly those with limited training or experience in managing such situations. The objective of this study was to evaluate the level of knowledge, attitudes, and behaviors of licensed doctors in Saudi Arabia concerning IMEs, and to identify the demographic factors influencing their preparedness. METHODS: A cross-sectional study was conducted with a sample of 383 licensed physicians across five regions of Saudi Arabia. Participants completed a self-administered questionnaire assessing demographics, knowledge of IMEs, attitudes towards providing assistance, and previous experience with in-flight emergencies. Data were analyzed using SPSS 26, with statistical significance set at P<0.05. RESULTS: The results revealed a predominantly young (75.8% aged 25-34 years) and male (69.6%) participant pool. While 76.6% of respondents recognized the impact of cabin pressure on oxygen, only 45.4% correctly identified air travel risks for asthmatic patients. Although 66.8% felt confident assisting in IMEs, 20.9% cited medicolegal concerns. Moreover, area of working within Saudi Arabia (P=0.020), year of experience (P=0.041), prior experience with IMEs (P=0.021), and IMEs training (P<0.001) had a significant association with levels of knowledge. CONCLUSION: The study highlights a critical need for enhanced training programs with a focus on the management of IMEs among healthcare practitioners in Saudi Arabia.

Background: Sepsis may increase the risk of long-term cardiovascular outcomes. This study aims to investigate association between sepsis survivorship and cardiovascular outcomes and to identify risk factors.

Methods: We conducted a comprehensive systematic search of MEDLINE, EMBASE, the Cochrane Library, Wanfang, and CNKI from database inception through May 2025, without language restrictions. The primary outcome was a composite of myocardial infarction, stroke, congestive heart failure, or cardiovascular death. To evaluate the association between sepsis survivors and cardiovascular outcomes, we calculated cumulative incidence rates and hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs).

Results: Twenty-five observational studies comprising 7,525,271 participants were included. The pooled cumulative incidence of major cardiovascular events was 9.0% (95% CI: 6.1%-11.9%), myocardial infarction 2.4% (95% CI: 1.6%-3.1%), stroke 4.9% (95% CI: 3.8%-6.1%), and congestive heart failure 8.6% (95% CI: 4.6%-12.6%). Compared with non-sepsis controls, sepsis survivors had a significantly higher risk of major cardiovascular events (HR: 1.54; 95% CI: 1.32-1.79), myocardial infarction (HR: 1.41; 95% CI: 1.29-1.54), stroke (HR: 1.45; 95% CI: 1.32-1.60), and congestive heart failure (HR: 1.51; 95% CI: 1.46-1.56). Risk factors associated with increased cardiovascular events in sepsis survivors included age ≤ 45 years, male, hyperlipidemia, and multiple comorbidities.

Conclusion: Adult sepsis survivors may face significantly increased risks of long-term cardiovascular outcomes. Both common cardiovascular risk factors and sepsis-related pathophysiological changes contribute to this association.

Background: Sepsis-associated encephalopathy (SAE) is a diffuse dysfunction of the nervous system resulting from sepsis originating outside the central nervous system. Elderly individuals (≥65 years of age) constitute a particularly vulnerable population comprised by a high burden of underlying diseases and complications, which frequently leads to underdiagnosis or misdiagnosis. These patients are at increased risk of long-term or permanent central nervous system impairment, making rapid and accurate diagnosis and treatment especially critical. The review is expected to promote improvements in the diagnosis and treatment of SAE in elderly patients, ultimately achieving more standardized and efficient SAE management.

Methods: We performed a literature search in four databases-PubMed, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang-from inception to April 2025 using bilinguals (Chinese and English).

Results: The diagnostic criteria for SAE in elderly individuals include the following: (1) sepsis; (2) new-onset neurological dysfunction; and (3) exclusion of other causes of neurological dysfunction. Physicians should develop tailored empiric anti-infective plans for elderly SAE patients, considering comorbidities, organ function, infection site, local bacterial spectrum, and resistance. The treatment protocol can be adjusted once the pathogen is identified. Stabilizing hemodynamics and ensuring cerebral perfusion are two fluid resuscitation strategies used in elderly SAE patients. An individualized approach to fluid resuscitation using restrictive fluid volumes should be employed. Supportive treatment for elderly SAE patients focuses on improving tissue perfusion/oxygenation, controlling blood glucose levels, and correcting internal imbalances. Early rehabilitation, nutritional support, cognitive training, and family-based emotional support are important components of comprehensive care.

Conclusion: The diagnosis and management of SAE in elderly patients support early recognition and timely intervention.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive technique used to control non-compressible torso hemorrhage. However, the optimal degree of partial occlusion that offers maximum therapeutic benefit remains unclear. This study aimed to identify the optimal partial inflation volume for REBOA.

Methods: In a swine model of hemorrhagic shock, nine healthy female pigs were randomly assigned to three groups based on balloon inflation volume: 30% (R30), 60% (R60), and 100% (R100) of the volume required to eliminate the contralateral femoral arterial waveform. Hemodynamic variables, fluid and vasopressor requirements, and biochemical markers were evaluated during balloon occlusion and resuscitation following 40% blood volume-controlled hemorrhage.

Results: The R30 group showed higher mean arterial pressure during resuscitation and required less fluid and norepinephrine than those of the R100 group. The mean heart rate significantly differed over time among the groups, with more gradual changes in the R30 group. Markers of ischemia-reperfusion injury (lactate, pH, blood urea nitrogen, and creatinine) similarly exhibited significant temporal differences. Post hoc analysis revealed significant pH differences between the groups. The plasma lactate and creatinine levels were significantly lower in the R30 group than those in the other two groups.

Conclusion: In this swine hemorrhagic shock model, partial REBOA with 30% balloon inflation maintained hemodynamic stability while reducing metabolic derangement compared with higher ballon volumes of 60% and 100% inflation. A strategy involving partial inflation targeting approximately 30%, followed by monitoring the blood pressure trend while using a vasoconstrictor, if necessary, may have potential clinical utility.